337- Daily Impacts - Avoidance

When Jodie invited me to participate in her What it feels like series, I had given her a 200-word text about my emetophobia, and had planed a small series of my own, but never thought I'd be at part 8,  4 months later! 

Part 1 for my complex-emetophobia was in post 280.  Daily Impacts's newest chapter's about Avoidance.


Several of my coping techniques in life have been those of avoidance, which I ended using in multiple situations, and depend on several phobias or traumatic causes. 

Upon research, I found that I use 3 types of avoidance, each with a different clinical name.

1. Conflict avoidance ; 
2. Avoidance coping ;
3. Avoidant personality disorder, which is the one I initially thought encompassed all the others. 

Before I discuss all these, we need to define the word coping : it pertains to all those behaviors we use to protect ourselves from psychological harm. 

Now, I can detail each of these avoidance types : 

1. Although I didn't learn this term from a therapist or anyone, I naturally learned to display conflict avoidance, which is the first of them, as a result of several elements : lack of self esteem,  beta personality, and these are both linked to my traumas - especially actively witnessing domestic violence. 

This avoidance comes from an inability to cope with arguments, screaming, yelling, and fighting. I didn't learn easy ways of dealing with contradiction, as the only examples I had as a child were violent ones. 

As described in the wiki hyperlink above for this type, it doesn't serve me well, as conflict issues aren't dealt with when I don't confront them. I have managed doing it very rarely in my life, only to stand my ground in toxic relationships (topic to come), and my problem in confronting thus far is that I systematically put an end to these friendships, instead of learning to find ways to improve them. 

2. The second type has multiple names : avoidance coping, or escape coping, or cope and avoid. All these describe a maladaptive coping mechanism - meaning they aren't actual coping with situations, as avoiding them reduces adaptation to situations ;  which could have been possible by learning how to cope.

As far as I understand it, I display avoidance coping in regards to triggering material on the screen (tv, movies and video games) ; in what I read (books, blogs) ; and many situations in which I could be faced with triggers. 

I use this type in regards to my emetophobia, coprophobia, carnophobia, and hemophpbia. You can read about them and their impacts on me in post 280. I avoid many situations and cannot watch or read many graphic shows, even if I know it's all make-belief ; the visual aspect triggers me nonetheless. I cannot read some things either, as words are also tough for me to deal with. 

3. Avoidant personality disorder, which we'll now call AvPD, is another type of avoidance. It's classified cluster C personality disorder. 

Let's define these : 
a) This cluster includes anxious or fearful disorders, including, aside AvPD, DPD (Dependent personality disorder) and OCD (Obsessive Compulsive disorder).
b) PD or Personality Disorders, are mental disorders which are enduring maladaptive patterns of behaviour, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. They develop early, are inflexible and associated with significant distress or disability.

In my case, the early development is during my childhood, subsequent to multiple traumas. 
In short : domestic violence, parents' divorce, being kidnapped by my own father from my mother, being brought to a new country, experiencing more domestic violence, adaptation stresses, bullying, political upheavals and terrorism. I discussed some on this blog under entries such as this, and others about traumas, and DV. 

Once developed, they remained with me, more or less all my life until now. They thus have been enduring. 

This AvPD is expressed in me as patterns of:

1. Severe social anxiety - I didn't know that I had this for over 30 years prior to my diagnosis of social phobia, for which I received CBT. (this last entry gives you access to all 25 sessions and exposures.) 
2. Social inhibitions ; feelings of inadequacy and inferiority. 
3. Extreme sensitivity to negative evaluation
4. Avoidance of social interaction despite a strong desire for intimacy. 

Like other suffers, I avoided social interactions due to many fears : 
Being ridiculed or humiliated, thought of as boring or lacking social graces - especially in view of my life in a religious cult, where I didn't learn them.
I feared I may be rejected or disliked, with the feeling that if and when it'd occur, it'd reinforce the lack of self-esteem which the cult had ingrained deeply in me. These were many words meant to break me, as explained, through conditioning. 

There, I experienced abuse and neglect regarding my psycho-physical well-being, where the sole concern was to save my soul, but not to feed me emotionally and physically towards a healthy life. 

Through portrayals of a dangerous and sinful world, I wasn't invited to interact with it, but to avoid it. I was told this almost on a daily basis, and thus, it's not any surprise the side effect would be an enduring avoidance of situations - as I developed multiple CPTSD's, and that some of their symptoms are Hyper-Alertness, and co-morbid with GAD (Generalized Anxiety Disorder), from which I also suffer as a direct result.  

I totally agree with these scientists who found, I do exhibit and experience high sensory processing sensitivity, and was raised in abusive, negligent AND otherwise dysfunctional environnement. I have always had extreme sensitivity and empathy, and always felt like my emotions were on over-drive, and that my brain was like one giant amplifier. Thus, physical and emotional stimuli were difficult to process and integrate, especially in view of my specific experiences, and from one avoidant act, I grew to avoid many, and then most situations.
I view my empathy as a positive personality aspect, but that I have to find proper balance in adaptability and coping. 

Avoidance is a disservice:

When we avoid situations, we believe that we are protecting ourselves, indefinitely. I know that I thought this, and that I'd be safe. For a time, it might have been true, but each time that I did so, I further complicated possible adaptation and thus avoidance became second nature.

I avoided so many invitations and situations, that I missed out on friendships, concerts, seeing movies in the cinemas, travels, and so many others. 

Each time I avoided a situation, I became less able to cope with similar ones, and in time, even different ones were impossible for me to attend. 

Alternatives to avoidance :

So, one day, I decided I had enough with missing out. I asked my psychotherapist to see him more often, and he sent me to the one alternative I suggest first: CBT, with gradual exposures to situations. After a failed first CBT, I changed CBtherapist and the second one gave me 25 sessions, with exposures and regular updates in LSAS (Liebowitz Social anxiety scale), which proved the next alternatives.

Modifying or eliminating the cognitive and emotional reactions to conditions and situations that gave rise to the problem of avoidance. By changing my perceptions of each experience individually, I could see that I was able to face many social situations, and became autonomous and more at ease in many, and as you can read in post 299 my avoidance levels reduced much more than the anxiety itself. I learned to face my fears, and avoid avoidance. 

I may not have fully neutralized my issues, but reduced my avoidance by 37% and anxiety by 17%. I am now able to continue this path alone, and my CBT shall address my complicated emetophobia, intertwined with 3 others. 

Let's summarize a bit. 

What causes avoidance ? (C-)PTSD symptoms are thought to be the precursors to avoidance coping. 

CPTSD and PTSD both put our brain in high-alert mode, on edge. The brain is on red alert. 

Many or all situations are viewed as potential dangers. 

Our cognitions and behavioral patterns can become generalized avoidance, through a posttraumatic hyper-alertness.

Most common symptoms are - drawing into oneself, avoiding relationships, social activities, interactions and situations. 

Common fears are of rejection, commitment, lack of self-esteem or confidence, indecision. 

Avoidance serves a purpose, for a time. That of avoiding overwhelming situations, when we're not ready to cope with them. In due time, we must learn to face the fears, and head on to solutions.

Solutions: 

Modification of patterns, through gradual exposures, if needed through therapy.

Part of un-learning this fear is to brave it, to dare doing something contrary to it, despite of it, in a calculated manner but daring nonetheless.

For me it was as extreme as changing my Facebook name from my wife's last name to my real one ; it was also learning to open up to others, take the risk of the friendship not going where I wanted, but also risking and realizing that life is full of such risks, where you dare something just enough where you may be hurt but where you may also gain a lot, through friends, or new independence, and so forth.

I found this beautiful illustration of how all this avoidance works, and the path to recovery, in one simple image :